D Troop
3/4 CAV Research Project will
focus on collecting oral histories from soldiers who served with D Troop in
Viet Nam during the second year of deployment (1967-1968)
Your participation will involve a recorded interview
of short duration. There are no foreseeable risks to
participation and the benefit will be a better
understanding of the experience of individual soldiers and the unit.
.
Principal Interviewers: Bain Cowell, Rick Arthur,
Charlie Johnson, Tom Fleming
Participant/Interviewee: ________________ญญญญญ____________________________
Date: ___________________________, 2010
As the Participant/Interviewee, I am aware of the
following:
1. With this consent form, I am giving permission to
use the following materials as part of the Research Project:
�� Personal details
�� Interview/s
[date____________________, place____________________________]
�� Audio recording/s
�� Video recording/s
�� Photograph/s I authorize D Troop
3/4 CAV Research Project to edit, copy, exhibit, publish or distribute the
photo(s) for purposes of publicizing the documentary. In addition, I agree that
I may not inspect or approve the finished product, including written or
electronic copy, wherein my likeness appears.
�� other (specify
:______________________________________________________)
2. My participation in this research is completely
voluntary and I understand the intent and purpose of this research and that my
name/image may appear as part of a publication relating to the Centaurs in
Vietnam.
3. Upon my request, I understand that my identity
will be kept confidential and that I have the right to withdraw from this
research until May 31, 2010 and can contact the researcher using the
information I have been given.
4. I know that I may refuse to answer any questions
or release any materials.
5. The results of this research will be used in a
documentary and/or scholarly papers or books which could be made commercially
available (published) or made freely available under a creative commons license
on the internet.
6. I understand that I do not give up any copyright
or performance rights that I may hold.
7. I understand that one copy of this interview will
stay with the researcher.
8. I give my permission for the researcher to use
this information without further approval on my part.
__________________________________ Signature of
Participant
__________________________________
Signature of Researcher